Our Department
María del Pilar Cuervo Polanco*, Margarita González Calderón**,
Luz Stella Gil Sánchez***, Claudia E. Cruz Jiménez°, Deisy Mora Maldonado°°
* Nursing Coordinator Nurse, Santa Fe de Bogotá Foundation.
Correspondence: [email protected]
** Head Nurse of Gynecology and Obstetrics Fundación Santa Fe de Bogotá.
*** Nurse Administrator of Surgery Rooms Fundación Santa Fe de Bogotá.
° Surgical Instrumentation. Head of Sterilization Fundación Santa Fe de Bogotá.
°° Surgical Instrumentation, Santa Fe de Bogotá Foundation.
Reviewed by: Jaime Toro, MD, Jaime Escallón, MD, José Félix Patiño, MD, Gustavo Quintero, MD, Juan Manuel Gómez, MD. Sandra Beltrán, MD, Fernando Guzmán MD, Enrique Arango, MD, Elsa Durán, Enf.
International pair: Alicia Lizzi Argentina, Enf., Griselda Almada, Enf, Argentina.
National Pair: Martha Arroyave Enf. Medellin.
General Purposes
This guide is designed in order to unify criteria in the management of asepsis and antisepsis and reduce the risks of infection.
The recommendations are based on evidence, according to the Center for Disease Control (CDC) of Atlanta, the nursing intervention guide for hospital-acquired infections made by the agreement between the Social Security Institute and ACOFAEN (Colombian Association of Nursing Faculties ), the AORN (Association of Operating Room Nurses).
The guide includes the precautions that staff must take to care for patients, the management of different hospital areas and the management of equipment (endoscopes, basic and specialized instruments).
Introduction
Since the pre-Christian era, changes and actions aimed at preventing infections have been occurring, many of these influenced by tradition(1-3). However, the use of current sterilization methods, novel surgical techniques (minimally invasive) and the establishment of standards for behavior in operating rooms have significantly controlled the occurrence of infections.
The recommendations are categorized according to the existing level of evidence (NE), theoretical rationalization, applicability and economic impact.(4-11) So it is possible to have a point of comparison with a leading organization in the study of hospital-acquired infection. and worldwide recognition.
These are categorized according to the strength of recommendation in:
• Category A. Satisfactory evidence supporting recommendations for use
• Category B. Moderate evidence supporting recommendations for its use
• Category C. Insufficient evidence to recommend or not recommend its use
• Category D. Moderate evidence supporting excluding its use
• Category E. Satisfactory evidence supporting excluding its use.
More information on Asepsis and Antisepsis:
- Asepsis and Antisepsis Part I, General Recommendations
- Asepsis and Antisepsis Part I, Recurrent cleaning
According to the quality of evidence in:
• Category I: Evidence obtained from at least one adequately randomized controlled clinical trial or a high-quality meta-analysis
• Category II: Evidence obtained from at least one well-designed but non-randomized clinical experiment, observational analytical studies, case-control studies preferably carried out in more than one center, or in multiple time series or studies with negative results in experiments not with -trolled
• Category III: Opinions of respected authorities based on clinical experience, descriptive studies or reports from expert committees.
Definition of Terms
Asepsis: absence of microorganisms that can cause disease.
This concept includes: the preparation of the equipment, instrumentation and field of operations through sterilization and disinfection mechanisms(3,10,12,13)
Antisepsis: use of chemical substances to inhibit or reduce the number of microorganisms on living skin, mucous membranes or open tissues to a level at which they do not generate infections.(1-3,8,10,12,13)
Cleaning: it is the mechanical removal using water and a detergent of all foreign matter from surfaces in general. It does not eliminate microorganisms but reduces their number.(10,12,13)
Disinfection: process that eliminates most pathogenic and non-pathogenic microorganisms from inanimate objects, except spores, through the use of physical or chemical agents. According to the antimicrobial activity, disinfection is classified as: (3,10,12,14)
- High level (DAN): procedure that uses physical or chemical agents with activity on bacteria in the vegetative phase such as Mycobacterium tuberculosis, fungi and viruses with a medium-sized lipid layer, except for spores.
- Intermediate level (DNI): germicidal action on bacteria in the vegetative phase, viruses with a medium-sized lipid layer (adenovirus, asexual spores but not chlamydospores, mycobacterium tuberculosis).
- Low-level disinfection (DBN): procedure by which it has an effect on bacteria in vegetative form, yeasts and medium-sized viruses but without action on the tuberculosis bacillus.
Decontamination or degermination: It is the reduction of the number of microorganisms in a material that has been in contact with liquids, body fluids or organic remains so that it can be handled safely.(10,12,13)
Sterilization: is the procedure in which chemical or physical methods are used to eliminate all possibility of microbial life, including spores and highly heat-resistant bacteria.(2,3,10,12) This method will be used in the presence of prions, until when Find another more effective method for these cases.
Area Classification
Institutional areas are classified as critical, semi-critical or non-critical according to the risk of infection generated by the activity carried out there.(12,15)
The operating rooms, delivery rooms, small emergency surgery room, sterilization center, dialysis units, parenteral solution preparation areas are considered critical or high-risk areas for infection.(12)
Semi-critical or medium risk areas for infection are intensive care units, hospitalization services, food services, emergencies, morgues and oncology.
Non-critical areas or areas with low risk of infection include offices, hallways, waiting rooms, consulting rooms, cardiac rehabilitation, neurology, physical rehabilitation, pulmonology and nuclear medicine.
Element Classification
Medical-surgical materials, articles or equipment can be divided into three categories according to the risk related to their use.
Critical elements: are those that penetrate internal or sterile cavities of the body including the vascular system. These can be: surgical instruments, central and peripheral catheters, implants, laparoscopes, sharp elements, valve prostheses, orthopedics, among others. These elements must be subjected to the sterilization process, or in emergency cases, high-level disinfection can be performed on the laparoscopes and/or arthroscopes.(2,3,10,12,15)
Semi-critical elements: these are all items that come into contact with non-intact skin and mucous membranes, such as respiratory therapy, digestive endoscopy, hydrotherapy, and cystoscopy equipment, among others. Requires high level disinfection (HLD).
Non-critical elements: are those that come into contact with the intact skin, oral mucosa or upper part of the digestive tract or do not make contact with the patient. Examples of non-critical items are hospital stretchers, bedding, blood pressure monitors, physical examination and electrocardiography equipment, among others. These elements must be subjected to low-level disinfection (DBN).(2,3,10,12,15,16)
The precautions that staff must take to care for patients and manage the different hospital areas and equipment will be specified below.
1. Staff
1.1. Handwashing
The skin microflora contains resident and transient microorganisms. Resident microorganisms survive and multiply on the skin. These can become highly virulent. While transient flora represents contaminants that can only survive for limited periods of time. Hand washing with soaps and detergents is effective in removing much of the transient flora and eliminating and inhibiting the resident flora.(2,4,8,11,17)
Handwashing is defined as a brief, vigorous rubbing of soapy surfaces, followed by rinsing under running water. Its objective is to reduce the resident flora (understanding the normal skin flora of the individual’s hands and forearms, which may be made up of pathogenic organisms such as Staphylococcus aureus), and also remove transient bacteria (understanding these microorganisms that are They are acquired through contamination with the environment, generally non-pathogenic).(4,14,16-18)
1.1.1 Indications (3,4,8,10,13,15,18,19)
• Upon arrival at the NE hospital: Category II
• Before performing invasive maneuvers such as performing peripheral or central venipuncture, urinary catheterization, aspiration of secretions. NE: Category IA
• Before caring for newborns, the elderly and patients in critical condition. NE: Category II
• Before caring for immunocompromised patients. NE: Category IIA.
• Before and after handling surgical, traumatic or wounds associated with an invasive procedure. NE: Category IIA
• Whenever it comes into contact with mucous membranes, blood and body fluids, as well as secretions or excretions. NE: Category IIA
• After caring for people infected or colonized with epidemiologically significant microorganisms. For example multiresistant microorganisms. NE: Category IIA
• After coughing, sneezing, blowing your nose or using the toilet. NE: Category IIB
• After handling inanimate objects such as urine measuring containers or secretion collection devices. NE: Category IIB
• Before putting on gloves and immediately after removing them. NE: Category IIB
• Before handling or preparing medications, regardless of the route of administration. NE: Category IIB
• Before serving, administering or eating any type of food. NE: Category IIB
• Between caring for one sick person and another NE: Category IIB
• When finishing work. NE: Category IIIB.